Parental satisfaction of child's perioperative care

The effect of virtual reality on the breastfeeding process: a randomized controlled study

OBJECTIVE

The aim of this study was to determine the effect of breastfeeding training given with virtual reality (VR) to postpartum mothers after cesarean section delivery on breastfeeding success and breastfeeding self-efficacy.

STUDY DESIGN

The research was designed as a prospective randomized controlled study. In total, 66 women were included in the study, with 31 in the control group and 35 in the intervention group. The study included mothers who had no vision or hearing impairments and no neurological disorder, who had received breastfeeding counseling during pregnancy, and who had given birth by cesarean delivery to a healthy baby. The control group received standard breastfeeding training while the intervention group watched a breastfeeding video with VR in the 4th and 24th hours after cesarean delivery. Research data were collected with the sociodemographic information form, LATCH Breastfeeding Charting System and Documentation Tool and the Breastfeeding Self-Efficacy Scale.

RESULTS

As a result of the research, the women in the intervention group were found to have higher mean scores for the Breastfeeding Self-Efficacy Scale in the 4th and 24th hours compared to the control group. Mean LATCH scores were also higher in the intervention group compared to the control group. There were linear correlations between the Breastfeeding Self-Efficacy Scale scores and LATCH Scale scores.

CONCLUSION

Breastfeeding self-efficacy and breastfeeding success of mothers who received breastfeeding training with VR at 4th and 24th hours after cesarean delivery were higher than mothers who received standard breastfeeding training.

CLINICAL TRIALS NUMBER

NCT06256822.

The Effect of Immersive Virtual Reality Application on Anxiety, Pain, and Parental Satisfaction in the Perioperative Process of Children: A Randomized Controlled Trial

PURPOSE

To determine the effects of virtual reality (VR) interventions on pre- and postoperative anxiety, pain, and parental satisfaction in children.

DESIGN

A randomized controlled trial.

METHODS

Children undergoing surgery for the first time and their families were randomly assigned to the control or VR group. The control group received conventional education regarding the perioperative process. The VR group watched a VR video illustrating the operating theater and explaining the perioperative process. The primary outcome of interest was preoperative anxiety, evaluated using the Children's State Anxiety Scale. Secondary outcomes of interest included postoperative pain ratings using the Wong-Baker Faces Pain Rating Scale and parental satisfaction scores using the PedsQL Health Care Satisfaction Scale.

RESULTS

The analysis included 70 children and their families (control = 35, VR = 35). Demographic characteristics were similar between the groups. Children in the VR group had significantly lower preoperative anxiety scores (p < .001) and postoperative anxiety scores (p = .010) compared to the control group. Parental satisfaction scores were significantly higher in the VR group (p < .001). The VR group had lower postoperative pain scores, but this difference was not statistically significant (p > .05).

CONCLUSIONS

Preoperative education using VR tours may reduce preoperative anxiety and increase parental satisfaction. However, the lack of baseline measurements limits our ability to definitively attribute these effects to the VR intervention. Despite this, VR is a promising nonpharmacological strategy for managing children's anxiety and increasing parental satisfaction.

CLINICAL IMPLICATIONS

Virtual reality interventions offer an effective nonpharmacological strategy for perioperatively managing children's anxiety and increasing parental satisfaction.

The effect of VR headsets used during burn dressing in children on satisfaction and anxiety level of their parents

PURPOSE

The aim of this study was to determine the effect of virtual reality used during burn dressing in children on the satisfaction and anxiety levels of their parents.

METHODS

The study, which was designed as a prospective randomized controlled trial, was carried out with the parents of children aged 5-10 years who visited the only burns unit of a hospital in the northern region of Turkiye between 5 July 2021 and 1 April 2022 for dressing. There were a total of 52 participants in the study, 26 in the control and 26 in the intervention group.

RESULTS

The mean age of the children was 7.31 ± 1.81 years in the intervention group and 7.08 ± 1.72 in the control group. After the dressing was applied to the children, the mean anxiety score of the parents of the children was found to be 0.09 ± 0.28 in the intervention group and 0.64 ± 0.53 in the control group. The mean nursing care satisfaction score of the parents in the intervention group was found to be 4.70 ± 0.50 while it was 2.80 ± 0.26 in the control group.

CONCLUSIONS

In the study, while the anxiety levels of the ones in the intervention group decreased after the dressing, their satisfaction levels with nursing care were found higher than the control group.

PRACTICE IMPLICATIONS

Nursing interventions that would reduce the pain and anxiety experienced by children during medical procedures are also effective in reducing the anxiety of parents, and therefore, they should be included in distraction efforts with their children.

Evaluación enfermera de la ansiedad prequirúrgica pediátrica: estudio cualitativo

Resumen Objetivo: explorar y describir cómo las enfermeras perioperatorias evalúan e interpretan el comportamiento del niño antes de entrar a quirófano, identificando las estrategias que utilizan para minimizar la ansiedad y las propuestas de mejora. Método: estudio cualitativo descriptivo mediante entrevistas semiestructuradas y observación participante de las rutinas diarias. Análisis temático de los datos. El estudio sigue las recomendaciones de criterios para la publicación de artículos de metodología cualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: cuatro temas surgieron de los datos: a) evaluación de la ansiedad o comunicación estrecha con el niño y su familia; b) valorando lo observado; c) manejando la ansiedad y d) mejorando la evaluación o propuestas de mejora para la práctica diaria. Conclusión: enfermeras evalúan la ansiedad en su práctica diaria de forma observacional utilizando el juicio clínico. La experiencia de la enfermera es determinante en la adecuada evaluación de la ansiedad prequirúrgica del niño. La falta de tiempo entre la espera y el momento de entrar a quirófano, la mala información que tiene el niño y los padres sobre el proceso quirúrgico y la ansiedad de los padres dificultan la evaluación y el manejo correcto de la ansiedad.

Avaliação de enfermagem da ansiedade pré-operatória pediátrica: um estudo qualitativo?

Resumo Objetivo: explorar e descrever como as enfermeiras perioperatórias avaliam e interpretam o comportamento da criança antes de entrar na sala de cirurgia, identificando as estratégias que utilizam para minimizar a ansiedade e as propostas de melhoria. Método: estudo qualitativo descritivo utilizando entrevistas semiestruturadas e observação participante das rotinas diárias. Análise temática dos dados. O estudo segue os critérios recomendados para publicação de artigos da metodologia qualitativa Consolidated Criteria for Reporting Qualitative Research. Resultados: quatro temas emergiram dos dados: a) avaliação da ansiedade ou comunicação próxima com a criança e sua família; b) analisando o que foi observado; c) controlando a ansiedade e d) melhorando a avaliação ou propostas de melhoria na prática diária. Conclusão: as enfermeiras avaliam a ansiedade em sua prática diária por meio da observação e usando julgamento clínico. A experiência da enfermeira é decisiva na avaliação adequada da ansiedade pré-operatória da criança. A falta de tempo entre a espera e o momento de entrar na sala de cirurgia, a escassez de informação que a criança e os pais têm sobre o processo cirúrgico e a ansiedade dos pais, dificultam a avaliação e o controle adequado da ansiedade.

Parental presence during induction of anesthesia in children undergoing tonsillectomy and adenoidectomy

OBJECTIVE

To investigate the effect of parental presence during induction of anesthesia (PPIA) in relieving preoperative anxiety of children undergoing tonsillectomy and adenoidectomy.

METHODS

One hundred and sixty children undergoing tonsillectomy and adenoidectomy were divided into the control group and the trial group. The control group received routine nursing in the operation room, while anesthesia was induced in the trial group children in the presence of their parents as part of the routine nursing. The differences in heart rate and mean dynamic pressure during pre-operative visit and anesthesia induction between the two groups were observed and recorded. The Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Induction Compliance Checklist (ICC) were scored. The anxiety status of the children and their family members in the two groups was scored at different times, and the psychological stress of anesthesiologists during anesthesia induction was scored by a visual analogue scale. The differences in each index between the two groups were compared. Operation time and costs in-hospital were also compared.

RESULTS

Compared with the control group, the heart rate and blood pressure scores as well as the ICC in the trial group were lower than those in the control group (P < 0.01). On comparing the scores of m-YPAS between the two groups, we observed that the scores of the children in the trial group were lower than those in the control group before entering the induction room and anesthesia induction (P < 0.01). There was no statistical difference between the scores of the children in the trial group and the control group on the day of operation and on the way to the operating room (P > 0.05). The nursing satisfaction scores of the family members in the trial group were significantly superior to those in the control group (P < 0.01). The scores of the visual analogue scale for psychological pressure of anesthesiologists during anesthesia induction were higher in the trial group than in the control group (P < 0.05). The operation time and costs in study group were both significantly higher than those of control group (P < 0.05).

CONCLUSION

PPIA can significantly reduce preoperative anxiety and surgical physiological stress response in children undergoing tonsillectomy and adenoidectomy, and it is worth being encouraged.

Nursing evaluation of pediatric preoperative anxiety: a qualitative study

OBJECTIVE

to explore and describe how perioperative nurses assess and interpret the child's behavior before entering the operating room, identifying the strategies they use to reduce anxiety and the proposals for improvements.

METHOD

descriptive qualitative study using semi-structured interviews and participant observation of daily routines. Thematic analysis of data. This study follows the recommended criteria for publication of articles of the qualitative methodology Consolidated Criteria for Reporting Qualitative Research.

RESULTS

four topics emerged from the data: a) assessment of anxiety or close communication with the child and their family; b) evaluating what was observed; c) managing anxiety and d) improving the assessment or proposals for improvements in daily practice.

CONCLUSION

nurses assess anxiety in their daily practice through observation using their clinical judgment. The nurse's experience is decisive for the appropriate assessment of the preoperative anxiety in child. Insufficient time between waiting and entering the operating room, lack of information from child and their parents about the surgical procedure, and parental anxiety make it difficult to assess and properly manage anxiety.

Application of Meditation Relaxation Training and Rosenthal Effect in Patients with Adenoidectomy

Objective

This study aims to explore the application effect of meditation relaxation training and the Rosenthal effect in patients with adenoidectomy.

Methods

This study included 94 children who underwent adenoidectomy in our hospital from April 2020 to May 2022 and were divided into a study group and a control group. The control group was given routine care, and the study group was given meditation relaxation training and the Rosenthal effect on the basis of the control group. The negative emotions, treatment compliance, complication rates, and nursing satisfaction of children's family members before and after the intervention were compared between the two groups.

Results

The results of this study showed that after the intervention, the CDI and SCARED scores of the children in the study group were significantly lower than those in the control group. The treatment compliance in the study group was significantly higher than that in the control group, and the incidence of complications was significantly lower than that in the control group.

Conclusion

The intervention of meditation relaxation training and the Rosenthal effect on children with adenoidectomy can relieve their negative emotions, improve treatment compliance, reduce the incidence of complications, and the children's family members are more satisfied.

Paediatric day-case tonsillectomy – parent satisfaction questionnaire

Objective

To assess parent or guardian satisfaction with a newly instituted day-case tonsillectomy programme at a tertiary paediatric institution.

Methods

After receiving ethical approval, an anonymous questionnaire was sent to the parent or guardian of every patient who underwent day-case tonsillectomy between July 2018 and December 2020.

Results

A total of 135 patients were included. The parent or guardian of each patient was sent a questionnaire to be filled in and returned. Ninety-two completed surveys were returned. There were high satisfaction levels, with 91.3 per cent of parents or guardians feeling comfortable bringing their child home, and 92.4 per cent of parents or guardians would recommend day-case tonsillectomy to another parent or guardian. Of the parents or guardians, 10.9 per cent needed to contact healthcare services in the 24 hours following surgery.

Conclusion

Day-case tonsillectomy has proven to be a safe, efficient service at our institution, with high satisfaction levels from patients and parents or guardians. Areas for improvement focused on communication at the time of discharge regarding follow up and analgesia.

Parental Satisfaction and Associated Factors Toward Their Child's Anesthesia Service at a Comprehensive Specialized Referral Hospital in Ethiopia, 2021: A Cross-Sectional Study

BACKGROUND

Parental satisfaction is a key measure of the quality of a child's anesthetic care. Understanding of parents' opinions and satisfaction about their child's anesthesia service in the hospital is vital for hospital funding and parent experience.

OBJECTIVE

The purpose of this study was to determine the level of parental satisfaction with their child's anesthetic care and the factors that contributed to that satisfaction.

METHODS

An institution-based cross-sectional study was undertaken between March and June 2021. A structured questionnaire with the background characteristics of parents and children was used to collect data. A total of 238 parents were included in the study. To find parameters linked to parental satisfaction with their child's anesthetic service, bi-variable, and multi-variable logistic regression analyses were used. Crude odds ratio and adjusted odds ratio with a 95% confidence interval (CI) were estimated. Variables with a p-value < 0.05 were considered statistically significant in multivariable analysis.

RESULT

The proportion of parental satisfaction toward their child's anesthesia service was 77.7% (95% CI: 72.3, 82.4%). Non-anxious, male, employed, and urban resident parents and parents of pre-medicated children were associated with high satisfaction scores.

CONCLUSION AND RECOMMENDATION

Overall, parents' satisfaction with their child's anesthesia service was promising. Parents who were non-anxious, male, employed, and lived in an urban area and whose child had received sedative premedication had high rates of parental satisfaction with their child's anesthetic care.Parents from rural areas, as well as worried and female parents, should receive extra care. Preoperative anxiety is reduced when parents are given enough and understandable information. Thus, the provision of comprehensive information on their child's anesthesia care process and psychological or emotional support to parents are necessary to boost their satisfaction.

Factors impacting parental and child satisfaction in the perioperative setting

Understanding the different modifiable and non-modifiable factors and their positive or negative influence on parental and child satisfaction is essential to providing high-quality perioperative care. The purpose of this review is to focus on the perioperative environment and to report the various modifiable and non-modifiable factors that are associated with satisfaction. We found that factors such as quality of clinician-patient communication, clinician attitudes, teamwork, shared decision-making, and improved perioperative information were associated with increased parent and child satisfaction. Interventions such as preparation programs integrating role-play, teaching of coping skills, and family-centered programs were highly rated by parents and children. Healthcare providers and institutions should consider the above variables when treating children and their parents in the perioperative setting.

Parental Psychosocial Factors Moderate Opioid Administration Following Children's Surgery

BACKGROUND

This investigation aimed to examine the impact of parental psychosocial variables on the administration of opioids to young children experiencing postoperative pain.

METHODS

Participants in this longitudinal analysis were children ages 2-12 undergoing tonsillectomy with or without adenoidectomy and their parents. Parents completed validated instruments assessing trait anxiety, perceived stress, and coping style before surgery, and children and parents completed instruments assessing pain and administration of opioids and acetaminophen on days 1, 2, 3, and 7 at home after surgery. The structure of the data was such that parents and children completed multiple data assessments making the data multilevel (ie, days of data within dyads). To address this issue of data structure, multilevel modeling was used to analyze the dataset.

RESULTS

Participants included 173 parent-child dyads (mean child age = 5.99 ± 2.51) recruited between 2012 and 2017. We found that parent-related psychosocial variables, such as trait anxiety, stress, and coping style, moderated the relationship between the child's pain and postoperative medication administration. Specifically, when predicting hydrocodone, the interactions between anxiety and pain and stress and pain were significant; when child pain was high, high-anxiety and high-stressed parents gave their children 19% and 12% more hydrocodone, respectively, compared to low-anxiety and low-stressed parents. When predicting acetaminophen, the interactions between anxiety and pain, a blunting coping style and pain, and a monitoring coping style and pain were significant.

CONCLUSIONS

These results suggest the need to identify parents who experience high levels of perceived stress and trait anxiety and use appropriate interventions to manage stress and anxiety. This may ensure children receive optimal amounts of pain medication following surgery.

Parental Satisfaction With Autonomous Pediatric Ambulatory Surgery Units

BACKGROUND AND OBJECTIVES

Ambulatory surgery is much favored in children, as they are usually healthy with no major comorbidities. Obvious benefits are minimization of health costs, optimal utilization of resources, decreased exposure to infections, and psychological and emotional advantages of avoiding admission of the patient, especially for the family. Parental satisfaction is a challenge in pediatric surgery processes. The objective of this study was to compare satisfaction in parents whose children underwent surgery without overnight stays with parents whose children were operated on in an autonomous major ambulatory surgery unit (hospital isolated).

METHODS

This was a prospective observational study of 200 children who received surgery on an outpatient basis (133 were included in an outpatient unit and 67 in a hospital setting). Different variables were collected, including sex, age, type of surgery, and length of stay in the hospital and location, and a telephone perception survey was conducted (questionnaire of satisfaction of 14 questions with possible answers from 1 to 4 on a Likert scale and a 15th question on global satisfaction, with an answer from 0 to 10).

RESULTS

Overall satisfaction during the hospital stay was higher in the group operated on in the autonomous major surgery unit (3.54 ± 0.57 vs 3.28 ± 0.64, P = .004). Whether parents respond as being very satisfied with the hospital stay is influenced by several factors, among which are: being treated at major ambulatory surgery units (odds ratio [OR] = 2.16), good or very good information received prior to surgery (OR = 2.03), and good or very good information received at discharge (OR = 2.48).

CONCLUSIONS

Parents of children who received surgery on an outpatient basis were more satisfied if the procedure was performed in an autonomous major ambulatory surgery unit compared with hospitalization, even if it was not overnight. The information received during the care process influenced the parents' satisfaction. These findings suggest that efforts should be devoted to the creation of autonomous units for ambulatory surgery and to the improvement of perioperative information.

The impact of parental health mindset on postoperative recovery in children

BACKGROUND

Mindset, or one's beliefs about the ability to change one's outcomes, has been studied in the educational domain but not in surgical settings. The purpose of this study was to examine the role of parental health mindset on children's recovery.

METHODS

Participants were part of a larger National Institutes of Health-funded trial that included 1470 children undergoing outpatient tonsillectomy and adenoidectomy. We used measures of parental coping style (Monitor Blunter Style Scale; MBSS) and medication attitudes (Medication Attitudes Questionnaire; MAQ) to validate the Health Beliefs Scale (HBS; Criterion validity, Cohen's kappa). HBS categorizes parents as having a growth mindset, or the belief that health can be changed, or a fixed mindset, which reflects the belief that individuals cannot change their health. Next, we identified demographic and personality variables (eg, temperament, anxiety) as predictors for the HBS. Finally, we examined the relationship between the HBS with postoperative outcomes.

RESULTS

Findings supported criterion validity of the HBS. Parents with a growth mindset reported seeking out more medical information (MBSS, 7.15 ± 3.32 vs 6.22 ± 3.38, P < .001, CI = -1.387 to -0.471) and reported fewer misconceptions regarding analgesic use (MAQ, 22.11 ± 4.09 vs 21.41 ± 4.25, P = .035, CI = 0.046 to 1.229). In assessing outcomes, we found that fixed-mindset parents rated their children's postoperative pain as more severe on days 1 (9.22 ± 3.82 vs 8.37 ± 3.71, P = .007, CI = 0.234 to 1.459) and 3 (8.13 ± 4.28 vs 7.27 ± 4.28, P = .007, CI = 0.094 to 1.638) and reported that their children received more doses of ibuprofen on postoperative day 1 (2.91 ± 1.24 vs 2.44 ± 1.44, P = .041, CI = 0.089 to 0.848). There was no difference in children's self-reported pain scores between groups (P = .585).

CONCLUSIONS

These findings, coupled with recent mindset intervention studies in the educational space, suggest that parent mindset is an important target for clinical intervention in the context of children's surgical recovery.

Practice horizons in pediatric nonoperating room anesthesia

PURPOSE OF REVIEW

Anesthesia outside the operating room is rapidly expanding for adult and pediatric patients. Anesthesia clinicians practicing in this area need a good understanding of the challenges of the NORA environment and the anesthetic risks and perioperative implications of practice so that they can deliver safe care to their patients.

RECENT FINDINGS

Recent reports from large patient databases have afforded anesthesiologists a greater understanding of the risk of NORA when compared to anesthesia in the operating room. Descriptions of advances in team training with the use of simulation have allowed the development of organized procedural teams. With an emphasis on clear communication, an understanding of individual roles, and a patient-centered focus, these teams can reliably develop emergency response procedures, so that critical moments are not delayed in an environment remote from usual assistance.

SUMMARY

With appropriate attention to organizational concerns (i.e. team environment, safety protocols) and unrelenting focus on patient safety, anesthesiologists can assist in safely providing the benefit of cutting-edge technical advancements to pediatric patients in these challenging environments.

Pediatric perioperative outcomes: Protocol for a systematic literature review and identification of a core outcome set for infants, children, and young people requiring anesthesia and surgery

Clinical outcomes are measurable changes in health, function, or quality of life that are important for evaluating the quality of care and comparing the efficacy of interventions. However, clinical outcomes and related measurement tools need to be well-defined, relevant, and valid. In adults, Core Outcome Measures in Effectiveness Trials (COMET) methodology has been used to develop core outcome sets for perioperative care. Systematic literature reviews identified standardized endpoints (StEP) and valid measurement tools, and consensus across a broader range of relevant stakeholders was achieved via a Delphi process to establish Core Outcome Measures in Perioperative and Anaesthetic Care (COMPAC). Core outcome sets for pediatric perioperative care cannot be directly extrapolated from adult data. The type and weighting of endpoints within particular domains can be influenced by age-dependent differences in the indications for and/or nature of surgery and medical comorbidities, and the validity and utility of many measurement tools vary significantly with developmental stage and age. The involvement of parents/carers is essential as they frequently act as surrogate responders for preverbal and developmentally delayed children, parental response may influence child outcome, and parental and/or child ranking of outcomes may differ from those of health professionals. Here, we describe the formation of the international Pediatric Perioperative Outcomes Group, which aims to identify and create validated, broadly applicable, patient-centered outcome measures for infants, children, and young people. Methodologies parallel that of the StEP and COMPAC projects, and systematic literature searches have been performed within agreed age-dependent subpopulations to identify reported outcomes and measurement tools. This represents the first steps for developing core outcome sets for pediatric perioperative care.